Screening Military Veterans for Post-Traumatic Stress Disorder (PTSD) in the Civilian Primary Care Setting

Abstract

Purpose: According to the National Center for Post-Traumatic Stress Disorder (PTSD), practitioners under-recognize and diagnose PTSD. Additionally, a common symptom of PTSD is avoidance of trauma reminders, which means that patients are likely to not report traumatic experiences or symptoms of PTSD they may be experiencing without being specifically asked by their health care provider. Thus, there is a need for routine screening of PTSD symptoms in the primary care setting. The purpose of the quality improvement project was to increase civilian primary care provider knowledge regarding the following: screening adult patients for veteran status and PTSD symptoms, knowledge of recommended interventions for those screening positive, and consistent use of standardized screening tools for veteran status and presence of PTSD symptoms. Theoretical Framework: The theoretical framework for this project was the Donabedian Model of structure, process, and outcomes. Methods: The process implemented included asking all adult patients their veteran status. If patients identified as being a veteran, they were administered validated PTSD screening instruments. Positive screens initiated a referral to treatment as outlined by the U.S. Department of Veterans Affairs (VA). Descriptive statistics will be used to evaluate the data collected in this project. Results: Of the 239 patients screened, 26 patients (10.9%) were veterans. Out of the 26 veterans, one patient (3.8% of veterans; 0.42% of total screened) screened positive on both the PC-PTSD and PCL-5, indicating a need for referral to treatment for PTSD. Therefore, the incidence of positive PTSD symptoms for this pilot study was 4.18 per 1,000. Mean age of participants was 52 years, while mean age of veterans was 71 years. For the total participants, 49.8% were male and 50.2% were female. The largest racial group represented was Caucasian, with 86.2% of participants identifying in this group. Almost half of participating patients were covered by commercial insurance (49.4%). Conclusion: This project implemented a new screening process in a rural primary care clinic to address potential PTSD symptoms in the veteran population. In the process, providers were given a toolkit for screening, resources, and additional training if desired. Patient were connected to resources for mental health crisis if screening positive for veteran status. Through implementation in the clinic, the screening of patients in the general population for PTSD was raised.